WikiDécision+

Outil d'aide à la décision

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english:project

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WikiDécision+ Project

The primary objective of this project was to adapt an existing DA about CPR to the context of a single ICU and to create an online CPR outcome prediction calculator tailorable to individual patient’s risk factors using the potential of wiki technology. The secondary objective was to document the use of a wiki platform for the adaptation of a DA.

We employed user-centered design to adapt the DA in a two-phase study during which we recruited patients, family members, intensivists and other allied health professionals from a closed medical and surgical ICU. During phase 1, we conducted three weeks of ethnography of the decision-making context in our ICU to identify clinician and patient needs for a decision aid. During this time, we observed five dyads of intensivists and patients discussing goals of care. We also conducted semi-structured interviews with the attending intensivists in this ICU. During phase 2, we conducted three rounds of rapid prototyping involving 15 patients and 11 other allied health professionals. We recorded discussions between intensivists and patients and used a standardised observation grid to collect patients’ comments and sociodemographic data. We applied content analysis to field notes, verbatim transcripts and the completed observation grids. Each round of observations and rapid prototyping iteratively informed the design of the next prototype. We also used the programming architecture of a wiki platform to embed the GO-FAR prediction rule programming code to create an online tailored CPR outcome prediction calculator. We also linked the calculator to a risk graphics software to better illustrate outcome risks calculated by the GO-FAR rule. During phase I, we identified the need to add a section in our DA concerning invasive mechanical ventilation. During phase II, we produced a context-adapted decision aid about CPR and mechanical ventilation (see “Patient Decision Aid” section) that includes a values clarification section, questions about the patient’s functional autonomy prior to admission to the ICU and the functional decline that they would judge acceptable upon hospital discharge, risks and benefits of CPR and invasive mechanical ventilation, population-level statistics about CPR, a synthesis section to help patients come to a final decision and an online calculator based on the GO-FAR prediction rule (see “GO-FAR calculator” section).

Our results inform producers of decision aids on the use of wikis and user-centered design to develop DAs that are better adapted to users’ needs. Free and open access to our wiki platform could allow other centers to adapt our tools to their local contexts thus reducing duplication and accelerating the scale-up of such DAs. Further work is needed on the creation of a video version of our DA. Physicians will also need training to use our DA and to develop shared decision making skills about goals of care.


Patient decision aid in English

Patient Decision Aid on Powerpoint

final_da_english.pptx

Patient Decision Aid in google slide adaptable

https://docs.google.com/presentation/d/1oOWHDY4nZjIOgGhi23dmhRZuRITpSsBxo1VMXUiWWvA/edit?usp=sharing You are free to modify, use, propagate this Patient Decision Aid without asking permission of the authors. However, we would like to be kept informed of its use. To do so please contact Patrick Archambault patrick.m.archambault@gmail.com —- ====== Good Outcome Following Attempted Resuscitation (GO-FAR) Score to Predict Neurologically Intact Survival After In-Hospital Cardiopulmonary Resuscitation ====== Original paper: Ebell et al <html><a target='_blank' href='http://archinte.jamanetwork.com/article.aspx?articleid=1735894'>http://archinte.jamanetwork.com/article.aspx?articleid=1735894</a></html> DISCLAIMER: All calculations must be confirmed before use. The author make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither Jonathan Rubins nor any other party involved in the preparation or publication of this site shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. Check each condition present on admission to the hospital to calculate total score and probability of survival. <html> <head> <title>Good Outcome Following Attempted Resuscitation (GO-FAR) outcome prediction rule calculator </title> <body> <script type=“text/javascript”> function checkCalcul(me) { var score=0; var select = document.getElementById(“Patient's age”); var valeur = select.options[select.selectedIndex].value; if (valeur == 'choix1') {score = score + 0; pronostic(score);} else if (valeur == 'choix2') {score = score + 2; pronostic(score);} else if (valeur == 'choix3') {score = score + 5; pronostic(score);} else if (valeur == 'choix4') {score = score + 6; pronostic(score);} else if (valeur == 'choix5') {score = score + 11; pronostic(score);} var listeChoix = document.getElementsByName('options[]'); for (var i=0, liste = listeChoix.length; i < liste; i++) { if (listeChoix[i].checked) { if (listeChoix[i].value=='1') {score = score -15; pronostic(score);} else if (listeChoix[i].value=='2') {score = score + 10; pronostic(score);} else if (listeChoix[i].value=='3') {score = score + 8; pronostic(score);} else if (listeChoix[i].value=='4') {score = score + 7; pronostic(score);} else if (listeChoix[i].value=='5') {score = score + 7; pronostic(score);} else if (listeChoix[i].value=='6') {score = score + 7; pronostic(score);} else if (listeChoix[i].value=='7') {score = score + 6; pronostic(score);} else if (listeChoix[i].value=='8') {score = score + 6; pronostic(score);} else if (listeChoix[i].value=='9') {score = score + 5; pronostic(score);} else if (listeChoix[i].value=='10') {score = score + 4; pronostic(score);} else if (listeChoix[i].value=='11') {score = score + 4; pronostic(score);} else if (listeChoix[i].value=='12') {score = score + 1; pronostic(score);} } } pronostic(score); } function pronostic(score) { if (score == 0){ document.getElementById('messageScore').innerHTML=“”; document.getElementById('messagePronostic').innerHTML=“ <img src='/data/media/prediction0_english.jpg' style='top: -221px!important;' class='graph'></a>”;} else if (score >= -15 && score⇐ -6){ document.getElementById('messageScore').innerHTML=“<b>GO-FAR score: ”+ score; document.getElementById('messagePronostic').innerHTML=“<b> Probability of survival to discharge with good neurologic status following CPR for in-hospital arrest (CPC 1) above average: 27.8% <a href='/data/media/prediction4.jpg' target='_blank'><img src='/data/media/prediction4.jpg' class='graph' alt='Chances de survivre avec un bon pronostic neurologique (CPC 1) au dessus de la moyenne: 27.8%'></a>”;} else if (score >= -5 && score ⇐ 13){ document.getElementById('messageScore').innerHTML=“<b>GO-FAR score: ”+ score; document.getElementById('messagePronostic').innerHTML=“<b>Probability of survival to discharge with good neurologic status following CPR for in-hospital arrest (CPC 1):Average 9.2% <a href='/data/media/prediction3.jpg' target='_blank'><img src='/data/media/prediction3.jpg' class='graph' alt='Chances de survivre avec un bon pronostic neurologique (CPC 1) dans la moyenne: 9.2%'></a>”;} else if (score >= 14 && score ⇐ 23){ document.getElementById('messageScore').innerHTML=“<b>GO-FAR score: ”+ score; document.getElementById('messagePronostic').innerHTML=“<b>Probability of survival to discharge with good neurologic status following CPR for in-hospital arrest (CPC 1):Low 9.2% <a href='/data/media/prediction2.jpg' target='_blank'><img src='/data/media/prediction2.jpg' class='graph' alt='Faibles chances de survivre avec un bon pronostic neurologique (CPC 1): 2.0%'></a>”;} else if (score >= 23){ document.getElementById('messageScore').innerHTML=“<b> GO-FAR score: ”+ score; document.getElementById('messagePronostic').innerHTML=“<b> Probability of survival to discharge with good neurologic status following CPR for in-hospital arrest (CPC 1): Very low <1% <a href='/data/media/prediction1.jpg' target='_blank'><img src='/data/media/prediction1.jpg' class='graph' alt='Très faibles chances de survivre avec un bon pronostic neurologique (CPC 1): 0.8%'></a>”;} } </script> <style> .graph { float: right; position: relative; height: 188px; margin-bottom: -188px; top: -259px; width: 490px; } @media screen and (max-width: 1020px) { .graph { float: none; position: initial; display: block; margin-bottom: 0; width: auto; height: auto; } } </style> Patient's age: <select id=“age” onClick=“checkCalcul(this)”> <OPTION>– Select age group —</OPTION> <option value=“choix1”> less than 70 </option> <option value=“choix2”> from 70 to 74 </option> <option value=“choix3”> from 75 to 79 </option> <option value=“choix4”> from 80 to 84 </option> <option value=“choix5”> more than 85 ans </option> </select><br> <br><b>PROTECTIVE FACTOR</b><br> <label><input type=“checkbox” name=“options[]” value=“1” onClick=“checkCalcul(this)” /> Intact neurologically or low neurological deficit at admission</label><br> <br><b>RISK FACTORS</b><br> <label><input type=“checkbox” name=“options[]” value=“2” onClick=“checkCalcul(this)” /> Major trauma</label><br> <label><input type=“checkbox” name=“options[]” value=“3” onClick=“checkCalcul(this)” /> Acute stroke</label><br> <label><input type=“checkbox” name=“options[]” value=“4” onClick=“checkCalcul(this)” /> Metastatic or hematologic cancer </label><br> <label><input type=“checkbox” name=“options[]” value=“5” onClick=“checkCalcul(this)” /> Septicemia </label><br> <label><input type=“checkbox” name=“options[]” value=“6” onClick=“checkCalcul(this)” />Medical noncardiac diagnosis </label><br> <label><input type=“checkbox” name=“options[]” value=“7” onClick=“checkCalcul(this)” /> Hepatic insufficiency</label><br> <label><input type=“checkbox” name=“options[]” value=“8” onClick=“checkCalcul(this)” />Admission from a skilled nursing facility </label><br> <label><input type=“checkbox” name=“options[]” value=“9” onClick=“checkCalcul(this)” />Hypotension or hypoperfusion</label><br> <label><input type=“checkbox” name=“options[]” value=“10” onClick=“checkCalcul(this)” />Renal insufficiency or dialysis </label><br> <label><input type=“checkbox” name=“options[]” value=“11” onClick=“checkCalcul(this)” />Respiratory insufficiency </label><br> <label><input type=“checkbox” name=“options[]” value=“12” onClick=“checkCalcul(this)” /> Pneumonia</label><br> <div id=“messageScore”></div> <div id=“messagePronostic”><a href='/data/media/prediction0.jpg' target='_blank'><img src='/data/media/prediction0.jpg' style=“top: -221px!important;” class='graph'></a></div> <p style=“float: right; position: absolute; right: 35px;”> Image: Icon Array</p> <form action=“” method=“post”> <p><input type=“submit” name=“submit” value=“Clear all”></p> </form> </body> </html> ^ Definitions of Predictor Variablesa ^^ ^ Variable ^ Definition ^ | Acute stroke | Documented diagnosis of an intracranial or intra-ventricular hemorrhage or thrombosis during the current admission | | Hepatic insufficiency | Evidence of hepatic insufficiency within 24 h of the event, defined by total bilirubin >2 mg/dL (to convert to micromoles per liter, multiply by 17.104) and AST > 2 times the upper limit of normal or cirrhosis| | Hypotension or hypoperfusion | Any evidence of hypotension within 4 h of the event, defined as any of the following: SBP <90 or MAP <60 mm Hg; vasopressor or inotropic requirement after volume expansion (except for dopamine ⇐ 3 microgram/kg/min); or intra-aortic balloon pump | | Major trauma | Evidence of multisystem injury or single-system injury associated with shock or altered mental status during the current hospitalization | | Metastatic or hematologic cancer | Any solid tissue malignancy with evidence of metastasis or any blood-borne malignancy | | Pneumonia | Documented diagnosis of active pneumonia, in which antibiotic therapy has not yet been started or is still ongoing | | Renal insufficiency or dialysis | Requiring ongoing dialysis or extracorporeal filtration therapies, or serum creatinine >2 mg/dL (to convert to micromoles per liter, multiply by 88.4) within 24 h of the event | | Respiratory insufficiency | Evidence of acute or chronic respiratory insufficiency within 4 h of the event, defined as any of the following: PaO2/FiO2 ratio <300, PaO2 <60 mm Hg, or SaO2 <90% (without preexisting cyanotic heartdisease); PaCO2, ETCO2, or TcCO2 >50 mm Hg; spontaneous respiratory rate >40/min or <5/min; requirement for noninvasive ventilation (eg, bag-valve mask, mask CPAP or BiPAP, nasal CPAP or BiPAP), or negative pressure ventilation; or requirement for ventilation via invasive airway | | Septicemia | Documented bloodstream infection in which anti-biotic therapy has not yet been started or is still ongoing | | Abreviations: AST: aspartate aminotransferase; BiPAP: bilevel positive airway pressure ; CPAP: continuous positive airway pressure ; ETco22: end-tidal carbon dioxide pressure ; Fio22: fraction of inspired oxygen; MAP2: mean arterial pressure; SaO22: arterial oxygen saturation; SBP: systolic blood pressure; TcCO22: transcutaneous carbon dioxide pressure . aAdapted from the American Heart Association.**

/home/wikidecision/public_html/data/attic/english/project.1488161864.txt.gz · Dernière modification: 2017/02/26 22:17 (modification externe)